HomeMy WebLinkAbout11-24-14 (2) ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
COURT OF COMMON PLEAS OF
COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of i '" ~� ,an Incapacitated Person
I. INTRODU TIOpN,
/— I / �/l/ I , was appointed
0 Plenary Obtinnted Guardian of the Estate by Decree of .J.,
dated
0 A. This is the Annualeport for the�eriod from /�/a h '`j a
to o '�� �� ,gL�!(the"Report Period");or
B. This is the Final Report for the period from ,
to (the"Report Perio." , and is fiW
c �C 70 M
for the following reason: a :;a �?
M c G) �
1. The death of the Incapacitated Person. Date of death: z rn ` c
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of- ry r= m
r11J.,dated �� "' o
Form G-02 rev.10.13.06 Page 1 of 5
Estate of Q ✓ ✓�� An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.) $ /I
C. What is the total amount of income earned during the
Report Period?
D. What is the total amount of income and principal I ✓
spent for all purposes during the Report Period?
E. What are the balances remaining at the end of the Report
Period? q 5
1. Principal $ U
2. Income $ 6
3. Total of Principal and Income D D- $ 0.00
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional pages)
A. Principal
1. How is the principal balance listed above currently
invested? (Please specify,e.g.,real estate,
certificates of deposit,restricted bank accounts,etc.):
2. Have there been any expenditures from the principal
during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . res Q No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . 'es O No
Form G-02 rev.10.13.06 Page 2 of 5
Estate of � � ` � ,An Incapacitated Person
b. List purpose and amount of expenditures:
$ T
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . ❑Yes b<O
3. Were additional principal assets received during the
Report Period which were not included in the ��
Inventory or a prior Report filed for the Estate? . . . . . . . . . . . F-1Yest'No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . ❑Yes ❑No
b. State the sources and amounts of the
additional principal received:
B. Income
1. State sources and amounts of income received
during the Report Period(e.g., Social Security, l
pension,rents,etc.): ,
$
Total income received during Report Period: $ 1 ro7 o:oo
3
I
Form G-02 rev.10.19.06 Page 3 of S
I
r
Estate of /— ,An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
[:]Yes [:]No
0 Yes 0 No
I verify that the foregoing information is correct to the best of my knowledge,
information and belief,and that this Verification is subject to the enalties of 18 Pa.C.S. §4904
relative to unsworn falsification to authorities.
.0 z c;;�' jai i�JDatT ignature of Guardian of the Estate
zon Z, ifJ Q C
Name of Guardian of the Estate(type or p 'no
1 �
Address
City,state zip
Telephone
Form G-02 rev.10.13.06 Page 5 of 5